Venous disorders
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
The deep veins of the lower limb (Figure57.1a) include three pairs of venae commitantes, which accompany the three crural arteries (anterior and posterior tibial and peroneal arteries). These six veins intercommunicate and come together in the popliteal fossa to form the popliteal vein, which also receives the soleal and gastrocnemius veins. The popliteal vein passes up through the adductor hiatus to enter the subsartorial canal as the femoral vein, which receives the deep (profunda) femoral vein (or veins) in the femoral triangle before passing behind the inguinal ligament to become the external iliac vein. The internal iliac vein combines with the external iliac vein in the pelvis to form the common iliac vein. The left common iliac vein passes behind the right common iliac artery to join the right common iliac vein on the right side of the abdominal aorta to form the inferior vena cava, which goes on to the right atrium.
Vascularized iliac crest grafts
John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan in Operative Oral and Maxillofacial Surgery, 2017
Attention must be paid to vessels branching off the pedicle which if violated will bleed causing a loss of pedicle visualization (Figure 28.5). These are best ligated with metal clips rather than using diathermy, to protect the pedicle. About 2 cm from the external iliac vessels, the ascending branches will join the pedicle, and at about this point, the vein which is 2–3 mm in diameter will start to dilate as it curves upwards and medially to course over the DCIA and external iliac artery before joining with the external iliac vein at a diameter of 4–8 mm. This requires meticulous dissection as the veins can be quite thin walled, and the wide vein with the 1.5–2 cm length over the artery that can be achieved may be crucial as the defect may not be ready for the flap. It is recommended to delay this dissection until the time has been reached for pedicle division and delivery of the flap.
Endovascular treatment of post-thrombotic iliofemoral venous obstruction
Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki in Handbook of Venous and Lymphatic Disorders, 2017
Perhaps most important, however, are the limitations in the current diagnostic criteria for the diagnosis of iliac vein obstruction with ultrasound. Current published criteria for stenosis are based on the identification of a 50% narrowing of the iliac vein when compared to adjacent normal venous segments.22 The problem inherent in this technique with post-thrombotic vein patients is two-fold. First, venous stenosis in post-thrombotic patients is most often long, diffuse stenosis involving entire venous segments (i.e., entire common iliac vein or external iliac vein). This is in contrast to the focal lesions seen in non-thrombotic iliac vein lesions (NIVLs) or arterial segments. Thus, without an adjacent normal segment to reference, no stenosis will be identified, resulting in a false-negative interpretation (Figure 46.2). Second, while it is generally accepted in the arterial system that a 50% lesion is significant, studies have suggested that a much smaller degree of vein stenosis can elevate venous pressures behind the lesion, contributing to disease. Since criteria are not readily available to diagnose lesions of less than 50%, nor has the degree of hemodynamic significance yet been determined, ultrasound studies in these patients may also be interpreted as normal.
Retroperitoneal liposarcoma in older person – a rare case report
Published in The Aging Male, 2020
Navas Nadukkandiyil, Sameer Valappil, Marwan Ramadan, Essa Al Sulaiti, Hanadi Khamis Alhamad
We report here a case of primary dedifferentiated liposarcoma in the retroperitoneum. A 77-year-old elderly gentleman was presented to our outpatient clinic with chief complaints of urinary incontinence for the last four years, weight loss >10 kg since 1 year, loss of appetite, tiredness and chronic constipation. On examination he had a mass in the right iliac fossa, measuring around 8 cm × 5 cm, hard in consistency, immobile and non-pulsatile on evaluation. He had microcytic hypochromic anemia and renal impairment with negative stool occult blood with all other basic investigation normal. Abdominal ultrasonography showed Ill-defined solid mass like area with vascularity are right lower quadrant measuring 11.4 × 11.5 cm. We proceeded with CT abdomen with contrast, which showed a large lower abdominal and pelvic retroperitoneal mass lesion occupying the midline and right lower abdomen measuring approximately 13 × 15 × 12.5 cm. The mass demonstrates inhomogeneous enhancement with a few small areas of necrosis. No calcification or definite fat component identified. The mass was encasing the right common iliac, external and internal iliac vessels with marked narrowing of the right common iliac and proximal external iliac vein. A short segment of a partially thrombosed right common iliac artery noted with atheromatous aortic calcification. Right pelvic ureter was displaced anteriorly and is markedly compressed at the level of the lesion with upstream moderate hydroureteronephrosis.
Faecal impaction causing bilateral pelvic venous thrombosis
Published in Acta Chirurgica Belgica, 2018
Maxime Dewulf, Yves Blomme, Cedric Coucke
In only one of the above, unilateral venous compression had led to a deep venous thrombosis (DVT) of the external iliac vein on the left side. Recent prospective data from asymptomatic patients with a CT-graphic diagnosis of iliac vein compression syndrome (IVCS), or Cockett’s syndrome, indeed show a low incidence of DVT [7]. In only 6 of the 500 included patients (with compression of the iliac vein) a DVT occurred during a follow-up of 12 months. A compression of the iliac vein of more than 50% appeared to be the only independent risk factor significantly increasing the risk of DVT. This is probably why a bilateral DVT of the iliac vein complicating venous compression by faecaloma is rare, and remained unreported so far.
Utility of right adrenal signature veins in venous sampling for primary aldosteronism
Published in Annals of Medicine, 2023
Zhenglin Shen, Shaoyong Xu, Siyu Guan, Bo Chen, Qingan Li, Ming Yu, Zhao Gao
For AVS, we inserted the 4F MPA 1 (Cordis Co., USA) catheter into the right adrenal vein (RAV) through the right basilic vein, median cubital vein, or cephalic vein [15]. Additionally, the 5F cobra (Cordis Co., USA) catheter was used for AVS through the right femoral vein. During the procedure, adrenal venography was performed in a posterior–anterior position and at a right anterior oblique angle of 30 degrees to confirm that the catheter tip was in the correct position. We collected peripheral venous blood from the external iliac vein.